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Virginia Center for Diabetes Prevention & Education

Registration Form

Diabetes Patient Tele-Education Program Registration

This registration form is to be filled out and submitted by the home participant or the program facilitator of each participating site. Please fill out the following to participate in our program:

  • Hospital, health department, community health center, etc. Those participating from home may provide their home address.
  • Please select the tele-education program(s) you or your site would like to participate in for March 2023. All classes are from 1:00 – 2:30 pm. Press and hold the COMMAND/ALT key and click on the class to make multiple selections.
  • Please select the tele-education program(s) you or your site would like to participate in for June 2023. All classes are from 12:00 - 1:30 pm. Press and hold the COMMAND/ALT key and click on the class to make multiple selections.
  • Please select the tele-education program(s) you or your site would like to participate in for October 2023. All classes are from 1:00 - 2:30 pm. Press and hold the COMMAND/ALT key and click on the class to make multiple selections.

  • Confirmation of Registration

    After submitting the form, you will receive a registration confirmation. Please be sure to click on the Program Resources link and download the handouts before each course. PARTICIPANTS: You will be sent a Zoom Link to be used to connect at the date and time of your chosen program(s). PARTICIPATING SITES: Please click on marketing resources and print out flyers and press release to be sent out to your participants. Before facilitating the program, please review “How to Participate” and print out the resources that you will need for the program.

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